Yet Another Study Says EMRs Contribute to Physician Burnout

A Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

5 Comments

  • Good to keep banging on about this problem.

    IMO the responsibility does NOT lie with “Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are”.

    Few vendor staff have ever set foot in a clinic/hospital and therefore reasonably have no clue how to set a balance between admin and clinical features or how effective/efficient a particular approach might be.

    Cookie-cutter medicine does not work – the only solution is for the docs to have a facilitator come in and map out the specific workflows they like to use.

    With this approach, aside from mandated long term outcomes data collection, all non-essential data collection will be eliminated from the “solution”

    The problem at a practical level becomes one of figuring out how to provide software environments that can be customized without the need for programming.

    This IS a an area vendors can/should focus on.

    A good starting position is to become able to host BPM (Business Process Management)templates in Adaptive Case Management environments.

    Anyone interested can look at 250+ articles on ACM/BPM at http://www.kwkeirstead.wordpress.com

  • As a busy physician, I disagree with your assessment. EHR’s largely don’t do what they are meant to. And we waste hours entering data that is often meaningless and difficult to find once entered. How is it that our current EHR (allscripts) lacks a search function to find test results or history details? how is it that simultaneously, my phone can search the entire web by voice command for complex answers to difficult questions? Why is it that the IT companies on the forefront of innovation and technical capabilities aren’t major players in this arena? All of these issues are major causes of frustration and dissatisfaction. on a daily basis they are the biggest issues causing burnout. It’s that simple: EHR’s aren’t good enough to do what they are supposed to. They are wasting our time and effort and burning us out.

    No, I didn’t enjoy paper charting but it was never the source of frustration that EHR’s currently are. And yes, there are other issues that add to burnout (eg: uncompensated and unproven work effort mandated by and exclusively benefitting payers) but the EHR is the gateway to almost all of the others.

    EHR’s = epic fail.

  • William,
    You make some great points. There are EHRs that do what you describe even though your EHR does not. That said, I can imagine the frustration. Although, I disagree with you that EHRs don’t do what they were meant to do. I think they do exactly what most of the people developing them intended them to do. The problem is that the customer assumed that they did much more than they were intended to do. Plus, the government through on a bunch of money and penalties which incentivized something that didn’t do what they thought it would do. Now we’re in the mess that you describe.

    I agree completely that EHRs are a reflection of the frustration and burnout that so many have with medicine. Sadly, I don’t see any way this is going to change in the future. Government regulations and reimbursement aren’t going to change. In fact, they’ll likely get worse.

    That said, there are many EHR that don’t have the problems that you describe. That are trying to free themselves from the burdensome government regulations so they can do creative and innovative things. It’s just a challenge when their users keep telling them to keep up with the latest government regulations.

  • John, the numbers don’t support your position. Medscape has done several surveys of thousands of docs on ehr’s and the “best” systems scored around 3.6 on a scale of 5. if that was my rating on healthgrades, i’d be financially penalized. the products are generally abysmal. I’ve tried and actually work with several. I can’t identify a single colleague that is satisfied with their EHR.

    “I think they do exactly what most of the people developing them intended them to do.” I could not have made my point any better. The people that developed them are rarely those tasked with providing care. what an inappropriate group to be chosen to empower with targeting the goals of development!

    I’m certain that you are correct in the point that regulations stifle innovation and entry into the field by the top IT companies but that doesn’t fully explain the drop in technological sophistication from everyday consumer electronics to EHR’s. the development of self driving cars would reasonably be far behind that of EHR’s but the converse is clearly true. It should be an embarrassment to the industry.

  • William,
    I think we mostly agree. In fact, your survey results illustrate my point. If you looked at the survey results pre-MU the satisfaction rate was much higher. That’s due to a number of factors, but illustrates both of our points.

    I don’t think we can place all of the blame on the developers. The majority of the market required EHR vendors to go become certified and make MU possible. That basically sucked up the past 3-5 years of EHR development and innovation.

    We definitely agree that it’s embarrassing how far behind many EHR systems are compared with other industries.

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